A Complete Guide on Filing Claims in Health Insurance

Filing health insurance claim involves paperwork and awareness of certain norms for a hassle-free experience. Let’s walk through the process to understand it better.A Complete Guide on Filing Claims in Health InsuranceIt is not difficult to make claims in health insurance, all thanks to the advent of the Internet. If you are aware of the proceedings, then things aren’t too difficult. If you have your documents nearby, the process becomes simpler. So, here’s a guide for filing health insurance claims-

There are two main ways to file health insurance claims

  • Cashless Claim
  • Reimbursement Claim

Both are two completely different procedures. So, the first thing you should do is read your insurance policy. And check –

  1. Whether you are entitled to a cashless claim
  2. If the hospital has an option for cashless claim

Cashless Claims Basics

As the name indicates, you don’t have to pay any cash or any hospital bills. As per your coverage, this amount would be paid by your health insurer. But, if your dues are more than your policy coverage then you will have to pay this extra amount.

How Cashless Claims in Health Insurance Work

Only the network hospitals of the Third Party Administrator (TPA) provides the cashless claims. These hospitals are registered as TPA and thus service your policy. Before getting admitted, you have to get proper authorisation for availing the treatment. Following are the things that you should do-

Read your policy and find the nearest cashless hospital. Check out the company website for closest hospital locators. You can also find these listed on your insurance policy.

  • Take your health ID card along with the health insurance claims.
  • Ask reception desk to give you a cashless request form. Fill up the form and submit it to the insurance help desk. You can also fax it to the hospital.
  • Next, you will receive an authorisation letter from the TPA/ insurance company.
  • Once you get the approval, get yourself admitted. Post the treatment; the bill will be settled directly with the hospital.
  • In case a rejection letter is sent, get in touch with your insurance provider.

For Reimbursement Health Insurance Claims

In the case of reimbursement claims, your health insurance would get cleared post the treatment. It is vital that you read your policy document carefully as there are several clauses and terms that one is required to understand. So, here’s what you can do-

  • You can consult with your insurance provider or executive before admission
  • Make sure that you adhere to policy norms. Like getting treated at a hospital within the network. You usually have 48 hours to inform the insurance provider after getting admitted. This can be done via phone, SMS, email, etc.

At the hospital, keep your documents ready. Some of these documents are listed below-

  1. First prescription of the illness which is being treated
  2. Medical advice citing hospitalisation
  3. Discharge summary of the hospital
  4. Final bill of the hospital
  5. Medical fitness certificate
  6. Test reports (pre and post hospitalisation)
  7. All vouchers/bills/receipts related to these tests
  8. Bills of the medicines purchased
  9. Completed and a signed claim form including the doctor’s prescription
  10. Mediclaim card or health insurance card

These documents must be submitted to the insurance provider. You can keep a photocopy of these for your reference.

Conclusion

As a rule of thumb, always read your policy for health insurance claims. The entire process of filing claims gets simplified once the documents are ready. So, make sure that the paperwork is complete.

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